Toxicology In The Michael Jackson Manslaughter Trial

Daryll748

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WOW that was a :blink: read...
Thanks for this 'interesting' thread Ivy...
as for my :2cents: here...
Propofol should ONLY be used for surgery PERIOD...
and CM acted really "suspicious in 'drugging' Michael... Docs are supposed to HEAL their patients NOT overdose them and KILL them... :mat:
 

cinzia

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... I believe he always sedated him using lorazepam and used propofol immediatley before awakining only to decieve MJ into thinking he was being sedated all night using propofol. That's what Murray does not want people to know.

I'm of those who believe what happened that day was identical to what was taking place everyday and that's how Murray was sedating MJ since day one....


Everything in that interview was a lie , there was no one trustful information in that statement.

But why? Why sedate with lorazepam with the attendant side effects then wake him up with flumazenil and resedate with prop? I mean that seems like a lot more work frankly for murray than just dripping in propofol and a lot less controllable.

As for the bolded part, I. could. not. agree. more.

Something has occurred to me. What happened to all the meds and IVs he ordered? Did he store them at his mistress house till he needed to use them, did he store them at Michael's residence? And where are the 'left overs' cause after the day Michael died I am sure there were unused drugs and IVs somewhere.
 

QuirkyDiana00

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You assume here Murray was telling the truth and MJ did not sleep all night , right !!!? I believe he did, I believe he wanted Murray to awake him at noon , and I believe he planned to have lunch with his kids at 12:30 pm as usual , and I believe all that sleepless night was a fabricated lie to blame MJ, to say he forced me, he begged for his milk he was mentally addicted , to justify why would he inject propofol into someone who was already sleeping for hours and his time to get up approached. I believe he always sedated him using lorazepam and used propofol immediatley before awakining only to decieve MJ into thinking he was being sedated all night using propofol. That's what Murray does not want people to know.

I'm of those who believe what happened that day was identical to what was taking place everyday and that's how Murray was sedating MJ since day one . .

That could be quite credible. But how would MJ know anyway whether he had been given propofol or not? Surely the effects of being sedated on lorazepam are different from being sedated on propofol, and wouldn't MJ know this upon waking? Also, if Murray was giving lorazepam via IV that frequently, what about tolerance? I am also of the opinion that Murray was not using a drip for weeks - if at all. I think Murray is only saying he used a drip previously so that he can claim he was weaning MJ off propofol, because really he had no reason to give propofol at all, unless he was weaning him off it. I agree - Murray is aware of how propofol is normally administered.....but what he was actually doing himself is another matter.

If MJ was sedated on lorazepam, why bother giving a propofol bolus at all? There seems to be no rationale for doing that and this sticks out the most for me.

What people should really note, and i mean really, is the fact that there was a miniscule amount of propofol in the urine. If MJ was asleep on propofol all night or for any good length of time, the propofol WOULD be detected in the urine at autopsy and the amounts would be greater than those found. So, an IV drip was not running through the night. The only possibility (even though it is not compatible with the equipment tested) is that Murray started a drip very late in the morning. The drip (if there was one) did not run for long because there is so little propofol in the urine. It would be useful to know roughly when MJ died. There is little rationale for starting an IV so late in the morning, and even less so if someone is already sedated on lorazepam.
 
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Soundmind

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ut why? Why sedate with lorazepam with the attendant side effects then wake him up with flumazenil and resedate with prop? I mean that seems like a lot more work frankly for murray than just dripping in propofol and a lot less controllable.

that in fact required much less attention and monitoring from Murray and was FAR LESS risky. The point of using propofol was not really to resedate, he wanted him to go through the usual feelings associated with awakining from propofol induced sedation. Monitoring for only 10 minutes instead of long hours would have required much less effort on lazy Murray's part , don't u agree? sedation using lorazepam was much less risky for someone who had no experience in administering propofol and did not even have infusion pump, don't you think so?

Surely the effects of being sedated on lorazepam are different from being sedated on propofol, and wouldn't MJ know this upon waking?

of course he would , that's why flumazenil is important . he bought large amount of Flumazenil as early as April , so it's fair to assume he planned to use flumazenil repeatdly, right? Sophie a great member here posted medical articles on flmazenil. Flumazenil does not affect the benzos concentration in the blood, it only block the benzos from affecting the nerveous endings. Its on set of action starts within minute and it reaches it's peack after 5 to 7 minutes . similar to average bolus injection of propofol .Due to it's short life and lorazepam's long half life , the person would suffer from the side effects of lorazepam later; lorzepam concentration was not affected by flumazenil it did not drop ,after a short period of time flumazenil's effect would have worn off . IF that what Murray was doing , MJ would not have known upon waking he was being sedated using anything but propofol because flumazenil was used , stopped lorazepam effect for a period of time , he went through feelings associated with awakining from propofol induced sedation but later in the day when flumazenil no longer had effect ,he would have suffered from all the symptoms caused by lorazepam and described by Kenny .
 

RedMaryFlint

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I think Murray is only saying he used a drip previously so that he can claim he was weaning MJ off propofol, because really he had no reason to give propofol at all, unless he was weaning him off it.
There is another possibility for why he relates this story. Detective Smith testified today to Murray's surprise upon learning that police had not already discovered the bags with the propofol and IV paraphernalia. The forensic pathologist testified to the fact that there was a cut in the rubber stopper of the propofol vial in the bag that was consistent with the bottle having been spiked. If Murray's explanations were being offered in the belief that the police had already found the drip apparatus and with the knowledge that Alvarez had seen it in place, then he may have been trying to portray its presence as routine and matter of course, nothing to worry about in the hands of a qualified doctor. In truth he may not have used it frequently, but its presence is a strong indication that he used it at least once, and it's incriminating in the overall picture of Murray's recklessness and failure to provide an acceptable standard of care.
 

QuirkyDiana00

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@ Soundmind - So you are saying that flumazenil temporarily blocks the action of the lorazepam but does not lower the actual blood level? Assuming this is correct, once the flumazenil wears off (how long would that be?) the effects of the lorazepam would become active again, so it would not be long before MJ would be suffering from those effects. I still don't know why Murray would bother to administer propofol (as per your theory) after the flumazenil......if you reverse the effects of lorazepam you would wake up, presumably with no drowsiness, so why would you then add propofol? MJ would still never know if he had been given propofol or not imo. Do you know how many flumazenil bottles were ordered and how many were found open at the residence?
 
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QuirkyDiana00

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The paramedic report states that at 12.33 MJ's heart was in PEA (pulseless electrical activity). It is written on the form as 'Pea'.

http://lady-medic.blogspot.com/2010/06/paramedic-run-formreportpcr.html

So, how long does a patient have to be down, for PEA to appear? I'm guessing not a huge amount of time. So Murray's last phone call - 11.55am? - could be very accurate in terms of when MJ was actually having problems. This is important because if a bolus was given and problems were going to occur, they'd pretty much occur straight away. So why would someone give a bolus near noon? If a drip had been started, why start it at that time in the day? If there was a drip, it had certainly not been going long judging by the tiny amounts of propofol in the urine in his bladder.
 
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QuirkyDiana00

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Murray was on the phone for 32 mins beginning at 11.18am. I believe that was a continuous phone call. That takes us to 11.50am. Murray then rang sade anding after this. That does not leave a lot of time to administer a bolus and even less time to set up and start a drip.
 

smoothlugar

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Actually that quote from murray's interview about the initial injection and drip of propofol does read as though murray is answering the detective's question about how prop is usually administered, not necessarily how it was done at 10.40am.

That particular quote yes, but there were others Dr. Steinberg provided that clearly refer to the last day: page 39, lines 21 and 22.

What I can see from the medical witnesses testimony is that it is not easy or simple to determine many things even for them with all their professional expertise. There are many variables to be taken into account, things they must rule out before making assumptions.
 

Autumn II

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There really DOES come a point where we must look to the experts? I have a lot of ad hoc knowledge, but have no specific medical training , specifically. Soundmind, and some others in this thread, do not, EITHER, so at some point I do think it's best that we understand this, and look to the experts? Sorry to have to say this, but experts are beyond a lot of our experience, and it's not ok to think we are getting accurate information, when we may NOT be? I can have an opinion, as a lot of people can, but in the end, there is a "medical experts" thread, just FYI?

http://www.mjjcommunity.com/forum/threads/119174-Medical-Information-Questions-and-Answer-thread
 

adrianmonk

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There really DOES come a point where we must look to the experts? I have a lot of ad hoc knowledge, but have no specific medical training , specifically. Soundmind, and some others in this thread, do not, EITHER, so at some point I do think it's best that we understand this, and look to the experts? Sorry to have to say this, but experts are beyond a lot of our experience, and it's not ok to think we are getting accurate information, when we may NOT be? I can have an opinion, as a lot of people can, but in the end, there is a "medical experts" thread, just FYI?

http://www.mjjcommunity.com/forum/threads/119174-Medical-Information-Questions-and-Answer-thread

the same problem you are referring to seems to be rampant (albeit to a lesser degree) in that thread too... :mello:
 

Autumn II

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the same problem you are referring to seems to be rampant (albeit to a lesser degree) in that thread too... :mello:

Yes, it IS rampant, elsewhere, too. I do not proclaim to be a "medical expert," and I don't presume to be. We DO have a viable medical experts threat, and I think we should appreciate that knowledge. We should also know the difference between those posts, and taking NON-experts posts as fact?
 

QuirkyDiana00

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I agree generally, i think the pharmacological aspects of this case are certainly better left to a pharmacologist to answer. However, you can pick up a lot of accurate information without having to be an expert in the field, and you can pose relevant thoughts and questions. Some things are just facts, other issues may need confirmation by the appropriate expert.
 

cinzia

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Regarding the urine results, the toxicologist made it abundantly clear, I thought, that urine results are an indication of history, what was given over time, ie., over possibly several days. The blood analyses, on the other hand, are accurate regarding what happened in the immediate time frame in which the death occurred. So the amount of anything in the urine is not useful in establishing what was given around the time death occurred. Therefore the amount of prop in the urine at autopsy is not relevant. What is in the blood is relevant.
This is my understanding.
 

elusive moonwalker

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Yes, it most def. can happen. IF the propofol bottle is connected to IV tubing just like the NS bag was and the bottle was vented with a needle, it could easily have had a needle placed at the end of the tubing and that needle then inserted into the 'Y' port. The propofol rate of infusion would then be controlled by a roller clamp. It's piggy backed into the primary IV. There would have to be a propofol bottle with a single ingress hole to support the theory of IV tubing. It would be easy to see. also... As was pointed out in another thread: (from the manufacturer) Not .9 Sodium Chloride.. Why didn't cm order Ringers or D5? or D5RL? Why infuse the propofol, however he did it, into something not listed as compatible? Just another question.eta: I'm puzzled as to why the one syringe had all three drugs in it: Prop, Lido and Flum. Did cm inject all at the same time? the Flumazenil to counteract the benzos while the prop. went into action OR did he just grab the first handy syringe to draw up and give the Flum. when he found Michael.
one of the things that confuses me is the long tubing having no dip in it and how the defence will use that to say there was no drip that night. u say the dip bottle was connected to where the syringe was. u mean it was connected via the spike that rogers talked about? but the why woukd it end up in the saline bag hanging as if it was been dripped. is a spike used if the dip was in the saline bag and been used as a make shift drift. but then we get back to there been no dip in the long tubing
 

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one of the things that confuses me is the long tubing having no dip in it and how the defence will use that to say there was no drip that night. u say the dip bottle was connected to where the syringe was. u mean it was connected via the spike that rogers talked about? but the why woukd it end up in the saline bag hanging as if it was been dripped. is a spike used if the dip was in the saline bag and been used as a make shift drift. but then we get back to there been no dip in the long tubing

i was wondering (sorry if this has already been answered/i am just forgetting) was there separate tubing attached to the cut open bag w/the propofol bottle in it? for some reason i was under that impression, because that's the only way that it would make sense that there was no propofol in the saline bag's tubing if he was receiving a drip, since only that one saline bag and tubing set was analyzed... i seriously don't understand why the other (cut) bag wasn't tested in the first place though.
 

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all the physical evidence was admitted, we saw no other tubing . Alvarez also said the saline bag with the cut and propofol vial had no tubing attached to it when he entered the room and it was the other clear salin bag that was attached to mj's leg .
 

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i was wondering (sorry if this has already been answered/i am just forgetting) was there separate tubing attached to the cut open bag w/the propofol bottle in it? for some reason i was under that impression, because that's the only way that it would make sense that there was no propofol in the saline bag's tubing if he was receiving a drip, since only that one saline bag and tubing set was analyzed... i seriously don't understand why the other (cut) bag wasn't tested in the first place though.
There was no tube attached to the cut bag. That's why I don't understand it either.
 

Soundmind

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it was the defense who asked for retest of the IV system, the clear saline bag, the long IV tubing , even the spike not only for propofol but for lidocaine also , the result for the second time came back negative that was before the preliminary hearing , because self-injection was to large degree ruled out by the expert in the autopsy report contrary to what the self impeaching coroner said during the trial thus the defense came with the drinking theory.

Let's see whether Schafer is going to rule out the self injection possibility .

He is the most qualified of all the experts to talk about the amounts found ,the survival time , the bolus and the drip story .
 

cinzia

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one of the things that confuses me is the long tubing having no dip in it and how the defence will use that to say there was no drip that night. u say the dip bottle was connected to where the syringe was. u mean it was connected via the spike that rogers talked about? but the why woukd it end up in the saline bag hanging as if it was been dripped. is a spike used if the dip was in the saline bag and been used as a make shift drift. but then we get back to there been no dip in the long tubing

Just to clarify, I was describing how you would normally piggy back one IV into another to show that it's not hard to do.
As for Why put the propofol bottle in a slit NS bag? Maybe the prop. bottle had no handle allowing it to be hung up and murray couldn't figure out how to use some tape and gauze to rig a holder. So he jams the spike through the access port of the slit IV bag into the propofol bottle, runs the medicine to the end of the tubing, attaches a needle and inserts it into the 'y' connector. It is abundantly clear that there is no medicine present in the IV tubing ABOVE the the 'Y' connector. So. Nothing, medicine wise, came from the 0.9% NS infusion hanging on the IV stand. Yet, if I understand the testimony, there was a propofol bottle showing the characteristic hole of a 'spike' which comes from an IV infusion set. Logically it follows that there must have been IV tubing inserted into the propofol. So where did it go? Why spike the propofol bottle if not to drip it in?
Did murray dismantle the IV tubing from the propofol and stick it in his pocket?
I have no idea.
The only other alternative I can come up with is worse: that cm bolused him to death with an overdosage.
 

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all the physical evidence was admitted, we saw no other tubing . Alvarez also said the saline bag with the cut and propofol vial had no tubing attached to it when he entered the room and it was the other clear salin bag that was attached to mj's leg .

There was no tube attached to the cut bag. That's why I don't understand it either.

Did murray dismantle the IV tubing from the propofol and stick it in his pocket?
I have no idea.

yep.. why not? assume that you killed someone due to your makeshift drift and you wanted to make sure that you wouldn't be found guilty. what would be the one piece of evidence that you'll and can take with you?

the tubing..
 

cinzia

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..There was lorazepam, midazolam, diazepam. Yes, they sound alike for a reason – they are all benzodiazepines, drugs whose profound effect on receptors in the brain and elsewhere include decreases in anxiety, impairment of cognition (though often the subjective sense that it’s improved) and muscle relaxation. And they are often used as sleeping pills...

Yet not midazolam. It’s main use is, not unlike propofol, intravenous. Intravenous midazolam “knocks you out,” obliterating memory – not a bad result if you’re trying to avoid the pain of the knife. But to inject midazolam for insomnia? No doctor I know uses it that way. And the potentially lethal respiratory depression provoked by benzodiazepines are far more likely when given intravenously – and in the form of multiple different benzodiazepines. Sleep is many things, but coma is not one of them. My guess is that Jackson was using propofol to get “knocked out,” after which the multiple benzodiazepines would start to work to provide their version of artificial sleep – with sleep staging and architecture quite different from normal. For naps, he might have used propofol and/or midazolam as continuous infusions.

The American version of sleep, often described as “lie down and die,” sadly equates unconsciousness with sleep. You lie down. Then you wake up. Sort of like turning the electricity on and off on your computer.

Except we’re not machines.

We’re alive. We survive through regeneration. The internal processes of human life work so fast that we use up most of the materials in our body quickly. Subtract skeletal elements like bones and teeth plus bits of DNA and you’re pretty much new in about a month – different from what you were before.

That is if you get enough rest. Rest is critical to that regeneration – like food. Even passive, undirected rest like sleep is critical to life – animals deprived of it die.

Michael Jackson was getting decreased consciousness with propofol and benzodiazepines, but it’s doubtful it was the kind of rest that normally regenerates your body.
http://www.therestdoctor.com/
The author is an internationally recognized expert on rest, biological clocks, performance, and sleep..

A slightly different take on whether it was benzos first then propofol or vice versa...either way murray exceeded his level of incompetence...It still bothers me that these drugs all cause some degree of amnesia for events so that when waking you don't remember what transpired beforehand. I have to wonder just how aware Michael was as to what he was receiving from cm. Seems as if cm could have told him what ever he wanted to and Michael would have no way to sift the truth from a lie.
If cm was giving benzos for 6 weeks or whatever then he was responsible for any addiction to them. And if he says he wasn't, then why order so much of the stuff. AND the antidote...Did he tell Michael he would wean him off the benzos using propofol? or wean him off the propofol using the benzos? Or did Michael even know he was receiving benzos every night, if he was?
 

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yep.. why not? assume that you killed someone due to your makeshift drift and you wanted to make sure that you wouldn't be found guilty. what would be the one piece of evidence that you'll and can take with you?

the tubing..

he left two syringes , the two propofol vialS, did not even bother to remove the saline bag with the cut before he called Alvarez , the paramedics were with him for 45 minutes with three bodyguards , left with him to the hospital but apparently no one saw that tube hiden into his pocket, we've seen pics of him arriving at the hospital, we certainly saw no tubing ,all the eyes were on him when he arrived at the hospital but he managed to get rid of it?!!

If the defense wants to refute this story they would do that easily with Schafer's help before even White takes the stand. Maybe they want to use it in their advantage , no expert can testify MJ could not have run the drip himself if indeed there was a drip prepared and ready to be used . We can only guess , but Chernoff stopping Flanagan from 'correcting' Dr.Nader on the drip that day was actually 'interesting' and very telling !!
 

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I agree with Ivy. Murray took away the tubing as the police did not find the black plastic bag that paramedic Sneff saw Murray putting stuff in when he came back up to retrieve his medical kit.

There must be a drip (with the propofol bottle in it) that piggy back on the saline drip, that is why there is Y connector. Murray said he gave Michael Lorazepam and Midazolam via drip. It must have been from the same tube, which I believe Murray took with him. He was hoping to come back for the rest of his stuff later but the bodyguard refuse to take him back and lock down the house.
 

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http://www.therestdoctor.com/
The author is an internationally recognized expert on rest, biological clocks, performance, and sleep..

A slightly different take on whether it was benzos first then propofol or vice versa...either way murray exceeded his level of incompetence...It still bothers me that these drugs all cause some degree of amnesia for events so that when waking you don't remember what transpired beforehand. I have to wonder just how aware Michael was as to what he was receiving from cm. Seems as if cm could have told him what ever he wanted to and Michael would have no way to sift the truth from a lie.
If cm was giving benzos for 6 weeks or whatever then he was responsible for any addiction to them. And if he says he wasn't, then why order so much of the stuff. AND the antidote...Did he tell Michael he would wean him off the benzos using propofol? or wean him off the propofol using the benzos? Or did Michael even know he was receiving benzos every night, if he was?

Thank u for the link .That's what I have been saying for more than a year now .
 

cinzia

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0625hospital.jpg


If Murray is the tall man on the left with the baggy t shirt and pants, as has been said, then I don't see any difficulty bundling up some narrow plastic tubing and sticking it into a pants pocket under the shirt. Not like it would be sticking out or anything. Much easier than disposing of an IV bag and bottles in the heat of a panicked moment. Then naturally anything left behind would be 'clean'...
Not saying he necessarily did it but the more I think about it, why not?
 

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Let's see whether Schafer is going to rule out the self injection possibility .

If he does rule out the self-injection possibility, then the defense experts, most likely, say that self-injection was still possible, I will be confused.
 

elusive moonwalker

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Thats what expert witnesses do. they both say the opposite and the jury decides. with something like self injection it could always be said theres a chance u could do it yourself unless u aint got no hands! or unless the iv was in the middle of your back? i guess it
comes down to whats more believable and logical
 

elusive moonwalker

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Thanks for explaining the iv. is it correct in saying the black bag wasnt found. there was a blue black bag found which i presumed was the one the medics talked about as it had lidocane vials in it
 

smoothlugar

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he left two syringes , the two propofol vialS, did not even bother to remove the saline bag with the cut before he called Alvarez , the paramedics were with him for 45 minutes with three bodyguards , left with him to the hospital but apparently no one saw that tube hiden into his pocket, we've seen pics of him arriving at the hospital, we certainly saw no tubing ,all the eyes were on him when he arrived at the hospital but he managed to get rid of it?!!

If the defense wants to refute this story they would do that easily with Schafer's help before even White takes the stand. Maybe they want to use it in their advantage , no expert can testify MJ could not have run the drip himself if indeed there was a drip prepared and ready to be used . We can only guess , but Chernoff stopping Flanagan from 'correcting' Dr.Nader on the drip that day was actually 'interesting' and very telling !!

If defense wanted to resort to the theory you are suggesting then why Murray should have worried to eliminate that long tubing and asked Alvarez to put the saline bag with a slit and the prop. vial inside it into a bag??? That in itself would prove Murray's own guilt of using such a device without a proper precision dosifier or infusion pump and waste precious time in hiding it instead of putting his patient first.

I also wonder why lorazepam and midazolam were not detected in the IV set if Murray used them intravenously as HumanNature says.

PS: Defense is constantly denying Murray used the drip that night. But as Dr. Steinberg pointed out on page 39 of Murray's interview with the police , lines 21 and 22, Murray is correcting the detective about the "same dose" but not about the drip. (Page 62, mentioned by the other doctor talks in general, not that night; page 39 refers to that night specifically).

PS2: I have scanned that page but cannot post it. Can anyone do it, please?
 
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